The sacroiliac (SI) joint is the large joint that joins the pelvis to the sacrum of the spine. It has limited movement, and helps in maintaining proper spine and pelvic alignment. Multiple ligaments and core muscles keep the pelvic bones and sacrum moving correctly. The joint is innervated by small branches of nerves from the sacral levels of the spine. Normally the joint is not painful. When the joint is not aligned properly or if it has become osteoarthritic, it may feedback painful signals. Pain from the joint is felt most commonly in the buttock region on the side of the dysfunction.
Many structures in the body can cause low back pain. The sacroiliac is a critical structure in helping transmit and cushion forces between the upper body and the pelvis and legs. When the joint does not move correctly, it may become a source of pain. Similarly, pain to the joint may also come from any nearby structure, including muscles, bursas, lumbar discs, lumbar facets, pelvic organs, and any of the nerves in the lumbar and sacral region. Furthermore, pain from another structure may cause muscles in the region to tighten and cause the sacroiliac joint to move abnormally and become painful as a secondary problem. Treating the SI joint then is only successful if the other problems are being managed.
Diagnosing Sacroiliac Pain
The diagnosis of sacroiliac joint pain is based on a combination of patient history, physical exams, radiologic studies and on diagnostic and therapeutic joint injection. Typical history is for pain in the region of the joint without a history of another problem in the area. An exam is not overly reliable, but stressing the joint region and direct palpation of the area often produces pain. X-rays and MRI scans sometimes show degeneration of the joint, but pain is not well correlated to changes seen on any of these studies. Unfortunately, the only reliable proof of pain from the SI joint is actual joint injection with subsequent pain relief after placing anesthetic into the joint.
Treatment of the sacroiliac joint ranges from the most conservative management to aggressive surgical interventions. The first line of treatment is with Physical Therapy. Strengthening and stretching of the muscles in the region is necessary. Anti-inflammatory medications and muscle relaxants may help control symptoms. Chiropractic or osteopathic type adjustments of the region may restore and improve mobility. If the above conservative management is not adequate, then consideration of injection of the joint under fluoroscopy with steroid and being evaluated by a Physical Medicine Pain Specialist would be reasonable. A Pain Specialist can help determine if there are multiple factors contributing to the SI joint pain and that more than just the joint needs further treatment. Recently, some surgeons have also been fusing the SI joint, but the outcome at best is guarded.
Pain Treatment in Minnesota
Pain in the sacroiliac joint can be simple or complex. It may be just the joint or it may be related to any combination of irritated structures in the lumbar region. If the simple management is not improving the pain, a full evaluation by a Pain Specialist may significant improve the outcome.
Thomas Cohn, MD
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